"Private practice by NHS doctors—still controversial?"

And before your very eyes I will now dismantle the NHS! This feat has never before been seen in public and may take some indulgence on the part of the audience.

I really don't see your point with either of those articles.

1. This is a well known issue where the titles of "sister" and "matron" are undeniably feminine and do put off young lads from seeking to be nurses. Every other major area of public sector working with clearly unisex titles has been changed so why not this?

2. I know many NHS consultant level doctors who work 60-80 hour weeks, 45-50 on the NHS and the rest on private practice. Why shouldn't they get to do this? Most earn more in the half work they do on private practice than they do on NHS work. Beyond wage jealousy, why should we stop NHS doctors having two jobs? If they want to work that extra time then they should get to keep the money. It's a shamefully weak argument that doctors artificially keep waiting lists high so that patients go do private work, the reasons for the high waiting lists are covered repeatedly over the previous 59 pages; it's not doctors that make the waiting lists high, it's the system around them.

Your last paragraph makes no sense at all when read with the article you post. You seem to forget that NHS and private practice have co-existed right from the very first days of the NHS and that's not going to change. If you get a zealot idiot Health Minister who demanded that NHS Consultants only do NHS work then you'd rapidly find many Consultants have less of a struggle with the thought that they could almost halve their hours while doubling their pay if they went fully private.

One the job being undervalued as in previous posts. When I hear people, even those in the job themselves, saying how much a role is worth on the open market I know this is part of the problem.

Two what that article was about was the acceptance of the agenda which I believe will end up meaning the death of the NHS and only private medicine being available. This is being done bit by bit, piece by piece.

What I find amazing is, you know how strongly I feel about the NHS but it's demise is on the cards. You would imagine that it's me attacking the NHS and that is the complete opposite if the truth.

I know we disagree on a few things ckn but the NHS isn't and won't ever be one of them .... how much private medicine on the other hand might well be.

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One the job being undervalued as in previous posts. When I hear people, even those in the job themselves, saying how much a role is worth on the open market I know this is part of the problem.

Two what that article was about was the acceptance of the agenda which I believe will end up meaning the death of the NHS and only private medicine being available. This is being done bit by bit, piece by piece.

What I find amazing is, you know how strongly I feel about the NHS but it's demise is on the cards. You would imagine that it's me attacking the NHS and that is the complete opposite if the truth.

I know we disagree on a few things ckn but the NHS isn't and won't ever be one of them .... how much private medicine on the other hand might well be.

Nurses have been undervalued since the first professional nurses were employed. They're professionally qualified individuals doing jobs for way less than their value to society. When you start going up the nursing ladder, it becomes even more apparent. That's not changed and is unlikely to do so. The country has long exploited that there's a very large pool of people in the country willing to put themselves through the difficulty to become a nurse then get underpaid and overworked.

The NHS's demise is most certainly not on the cards. No private company would touch the NHS urgent and emergency care work because it's just too damnably expensive. One credible analysis I read showed that the NHS budget would have to almost double before a private company could be sure of making a profit out of these parts of it. Any government that allowed those parts to become insurance-based would see themselves out of power within days of it becoming law, if their MPs ever allowed the government to get that far. Only the most blinkered and, frankly, sociopathic MPs even think that the NHS could provide half of the standard of care it does under an insurance based system; some of the sociopathic ones even are quite happy to accept the nation getting bent over the healthcare insurance barrel because it wouldn't affect them negatively, they can afford it out of cash and their taxes would go down by a long way.

It's the edge bits of the NHS that are being starved of oxygen and that's been covered to death in the pages above.

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Nurses have been undervalued since the first professional nurses were employed. They're professionally qualified individuals doing jobs for way less than their value to society. When you start going up the nursing ladder, it becomes even more apparent. That's not changed and is unlikely to do so. The country has long exploited that there's a very large pool of people in the country willing to put themselves through the difficulty to become a nurse then get underpaid and overworked.

The NHS's demise is most certainly not on the cards. No private company would touch the NHS urgent and emergency care work because it's just too damnably expensive. One credible analysis I read showed that the NHS budget would have to almost double before a private company could be sure of making a profit out of these parts of it. Any government that allowed those parts to become insurance-based would see themselves out of power within days of it becoming law, if their MPs ever allowed the government to get that far. Only the most blinkered and, frankly, sociopathic MPs even think that the NHS could provide half of the standard of care it does under an insurance based system; some of the sociopathic ones even are quite happy to accept the nation getting bent over the healthcare insurance barrel because it wouldn't affect them negatively, they can afford it out of cash and their taxes would go down by a long way.

It's the edge bits of the NHS that are being starved of oxygen and that's been covered to death in the pages above.

I'm not sure what point you're making here apart from people will turn up even if you treat them like dung and it's always been like that so what can you do? Along with your understanding of which bit's are suffering in particular .Sorry if I've misunderstood.

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I can see an argument for changing job titles so a sister becomes a Nurse Supervisor and a Matron a Nurse Manager or something similar just to as much as anything allow non NHS people to realise where those roles fall seniority, responsibility and experience wise.

As for the NHS/Private split, I dont care what someone does outside their contract as long as it does not impact on the contracted NHS work either in terms of competing (driving patients to their private work) or Safety (I am not sure someone working 80 hrs a week in a life or death role is really safe)

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The "spin" is now against the GPs I've noticed for daring to comment that they're less than impressed their pay rise is below inflation yet again while the rest of the NHS is getting the "headline" 3%.

It's an outright bit of deceit just counting patient contact time. The equivalent would be saying that only time in front of pupils should count for being a teacher, lazy sods that they are*, or that soldiers should only get paid when they're in combat zones. GPs are spending more and more time away from patients to meet the increasing bureaucracy of the NHS.

Here's one example, I've been brought in to help one area of London move much of the GP at-scale stuff from the commissioners and other (mainly bankrupt) providers to the GPs. On paper, it's a great idea. In reality, GP practices are massively admin-light with many GPs already being small business owners, this new work requires them to effectively run this new work as well for almost no new money. I regularly have late evening meetings, meetings before clinic, meetings over lunch and meetings after clinic with these GPs being accused of being slackers, all because grossly overworked GPs are having to do their patient clinics, practice admin, regional admin and now the at-scale admin.

To keep any sort of work/life balance and working hours under 50, GPs are having to cut back patient clinics to do the admin and other work. We run a monthly protected training initiative where all GPs are trained in best practices (essential training) but that's a whole afternoon out. Then there's the other training that's mandated because otherwise GPs become unsafe due to not knowing the latest rules and practices. Then there's the other stuff such as GP training where senior GPs train junior doctors (how else do junior doctors become GPs).

Back in late May, we had to get an abysmal document** out and I had GPs working with me to around 2am on Monday morning with clinics starting in a few short hours, I had to kick them out to go get some rest. Lazy sods that they are.

GPs want to go to the international standard of 15 minute appointments for patients as 10 minutes is "in, ONE problem, out" while 15 minutes gives time for the preventative stuff of "while I'm here" that saves lives. NHS England makes it clear that GPs can do that if they want but they'll only be paid for 10 minute appointments, effectively meaning GPs would have their income cut by 1/3 if they went to that international standard.

So, when you see stories like this, just think about the lies and deceit behind them. Yes, GP:patient time is going down but that's entirely the fault of the system that's pushing it that way, not the GPs themselves.

* sarcastic comment for those who don't get it...
** our document was quite good, the whole premise of why we had to do it was abysmal

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“The Tories’ expansion of the internal market has led to one-third of contracts being awarded to private providers since the Health and Social Care Act. Some of these contracts are vast and their failures have wasted millions of pounds of public money. "

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“The Tories’ expansion of the internal market has led to one-third of contracts being awarded to private providers since the Health and Social Care Act. Some of these contracts are vast and their failures have wasted millions of pounds of public money. "

Here's a perfect example. Essex. The IT contract for the commissioners and GPs has changed hands 4 times since 2012. In 2012, it was Essex Shared Service Authority, that contract moved to NHS Central Eastern CSU when the Lansley reforms took effect. "Mobilisation cost" involved. In 2014, Central Eastern CSU folded, NEL CSU took it as an emergency contract. "Mobilisation cost" involved. 2015, service was reprocured meaning a procurement cost (6 figure all-in). NEL CSU won again but had to do more change as a result, more "mobilisation cost". 2018, another procurement (another 6 figure cost), Arden & GEM CSU won this time around and a 7 figure "mobilisation cost".

All while exactly the same staff in exactly the same building keep doing exactly the same work for exactly the same "customers" but under a different brand. My view is that a comfortable high 7 figure sum has been lost just shuffling the brand around between different NHS organisations on this one contract alone. And there are literally thousands of contracts for things like this, keeping contract managers and procurement folk in jobs doing nothing but starting on a procurement list, working to the bottom and then starting at the top again.

THAT's the true impact of the Lansley Reforms in a nutshell and what he was so desperate to bring in. Not a single mention of the word "patient" in a single contract since 2012. The only time "patient" is usually mentioned is either as a cost or as a revenue generator.

It's an utter disgrace of a system that does nothing but cost lots of money and lots of disruption to routine NHS business.

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It's an utter disgrace of a system that does nothing but cost lots of money and lots of disruption to routine NHS busines﻿s.

It's a system designed to discredit the NHS. Then they can talk reform and sound reasonable. And they'll engage you in the discourse call it a consultation and then take no notice of what the finding are or the research says needs to be done.

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Meeting today to talk about GP numbers in the area and our “share” of the extra promised recruitment. Previous meetings put the number we needed in the area at 350 more than the UK and EU expected recruitment for the year. So, an international GP recruitment scheme was started. The number recruited now the scheme has finished: 0. Zero. Not a single international GP wanted to come AND could get a visa.

FFS.

Another item on the agenda was the GP Forward View point about restoring “joy to the workplace”. People were unhappy about “joy” as they felt it was taking the proverbial given the workload pressures. So, we’re no longer aiming to get “joy in the workplace”. It was like a bad parody sketch... maybe like a poorer W1A.

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Still on GPs, Jeremy Hunt's plan for 5000 new GPs by 2021 has made some progress. We're at 6429 needed now having lost over 500 more in the three months from April to June (33,163 - down 533 from 33,686 at end-March). When Hunt made the pledge for 5000 more in 2015, the total was 34,592.

One area I know has an average GP age of 55 with those already at maximum pension entitlement. The numbers of GPs are falling as the older ones retire and too few younger ones and foreign recruits come in. That means the same number of patients for fewer GPs meaning more pressure on them, more discontentment and lower quality of care for the patients. Eventually it'll reach a tipping point where the work becomes so overwhelming that more GPs will quit and not be replaced. Then into a vicious circle of fewer GPs and a toxic environment making even fewer new recruits want to move there.

Chronic mismanagement by the not so great and not even close to good at the top of the NHS food tree.

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Has to go here but some people really need to be publicly flogged over it. The England-wide figure for children aged 2-5 qualifying for, and getting, their 2nd MMR vaccination dose is 87.2%. Getting to the point below the herd immunity protection.

In my very blunt opinion, every single anti-vaxxer still peddling the lies about vaccinations deserves to be treated like they're advocating for widespread child abuse.

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Has to go here but some people really need to be publicly flogged over it. The England-wide figure for children aged 2-5 qualifying for their 2nd MMR vaccination dose is 87.2%. Getting to the point below the herd immunity protection.

In my very blunt opinion, every single anti-vaxxer still peddling the lies about vaccinations deserves to be treated like they're advocating for widespread child abuse.

Simple solution no publicly funded pre school care (or nursery vouchers etc) for any child who is not either immunised or has declaration from a Dr saying they are unsuitable for vaccination (I know there are some people who cant be due to medical conditions etc), if people want separate vaccinations then fine let them go pay for them but the main thing is that to be allowed into a mass social setting with other children that % has to be above the amount to confer herd immunity

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NHS Trusts will have their budgets reduced by a total of £510m from next year to help pay for a new national procurement body. How can ONE body COST £510m to run when it's nothing more than a procurement organisation?! It's not as if it's a manufacturer, storage firm or distribution organisation, it's a sodding procurement organisation!

Its predicted savings, with zero evidence that it can save anything is, £600m. NHS organisations are free to use other procurement options if they can save money. If a Trust can save more than a national organisation dedicated to nothing but procurement then some people really need to be given the bum's rush from employment for life.

In essence, Trusts will have to pay 0.4% of their tariff income to do this. For example, a NHS hospital trust with £500m tariff income will have £2m of that deducted to cover the procurement overheads whether they use the new system or not.

You really have to wonder what planet these people live on.

The NHS is woefully incompetent at procurement in general. SOME organisations are quite good but they're treated like they have wet leprosy just in case their efficiency spreads.

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Central purchasing is something I have thought is a painfully obvious procurement route for the NHS.

I would like to think those behind this move have spent time closely studying the Trusts that are most efficient.

Here's hoping.

Having tried to sell to the NHS the simple answer is "no" - what follows is how i saw it from outside the NHS, I am sure someone like CKN is able to actually give an insider's view as I am sure I only saw part of the picture - i have changed the £ involved to bring them to current equivalents but this actually happened about a decade ago

I work in recruitment so to give an example - in the past there was localised IT and the manager would ring up and say "we are doing a rollout can i have an extra helpdesk person to cover the summer months when other staff are taking holiday etc, I just need someone good on the phone with the basics of desktop support". I would say "yes how about a computer science student ?, they will be paid £10ph on a PAYE temp basis and that will cost you £15ph all in inc holiday and employers NI, I would then put the person in over the summer and everyone was happy (ps that is about £2.20ph gross margin to the agency)

Then they centralised procurement and "staffing" came under that, he had to initially try and see if the "bank" had anyone which they would have as they are mainly medical staff, that took a week due to the internal agreement for preference to use them. Then all non "bank" recruitment had to be via a framework agreement. We sort of tried to get on that but it covered all recruitment on non specialist medical personnel so was 95% irrelevant to us. The document took someone a week to complete and had to be delivered in hard copy to a certain room in a certain building by a set time in a plain Brown envelope with just a reference number on the outside (no joke those were the rules). It was about 100 pages long. We didnt get on the PSL instead a big agency that had both nursing and IT divisions did. But now all recruitment being centrally managed meant it also had to fit NHS bands (but only on the charging side), so talking to the manager the following summer (just before he resigned as soon as he had hit enough pension years) his summer IT bod he had to ask "bank" wait a week for them to admit they couldn't help then go via the central framework and get sent someone no better than I would have provided but who was being charged to him at over £20ph - that same agency managing those people has been dragged through the courts many times for "rolling in holiday pay" to make it look like people are being paid more than they are (as in they would be told they were getting £11ph but were actually getting £9.82 when you took into account rolled in holiday). 1 year later the trust decided to outsource IT due to spiralling costs

Edited August 24 by SSoutherner

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The NHS highheidyins are complaining about the year-on-year increasing waiting lists and the reduced of elective (i.e. non emergency) activity in hospitals. The total is around 8% up and down respectively. (Paywalled link but the headline covers it).

Now, you might think the NHS highheidyins have a point in complaining. Until you remember that the same people ordered hospitals to not do any elective activity in January because they'd (the NHS top level, not the hospitals) screwed up their winter planning so badly. It doesn't take a genius to work out that 1 month less activity out of 12 roughly equates to 8%. One month of no elective operations in a year means that 8% goes onto the waiting list and 8% lower activity.

I despair at the imbecility of this lot...

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1. This is a well known issue where the titles of "sister" and "matron" are undeniably feminine and do put off young lads from seeking to be nurses. Every other major area of public sector working with clearly unisex titles has been changed so why not this?

2. I know many NHS consultant level doctors who work 60-80 hour weeks, 45-50 on the NHS and the rest on private practice. Why shouldn't they get to do this? Most earn more in the half work they do on private practice than they do on NHS work. Beyond wage jealousy, why should we stop NHS doctors having two jobs? If they want to work that extra time then they should get to keep the money. It's a shamefully weak argument that doctors artificially keep waiting lists high so that patients go do private work, the reasons for the high waiting lists are covered repeatedly over the previous 59 pages; it's not doctors that make the waiting lists high, it's the system around them.

Your last paragraph makes no sense at all when read with the article you post. You seem to forget that NHS and private practice have co-existed right from the very first days of the NHS and that's not going to change. If you get a zealot idiot Health Minister who demanded that NHS Consultants only do NHS work then you'd rapidly find many Consultants have less of a struggle with the thought that they could almost halve their hours while doubling their pay if they went fully private.

I remember turning up at Doncaster Royal to see a specialist 38 years ago along with a dozen others, we all got told the specialist had been called away and we could see a junior, after I'd finished I caught the bus into Doncaster and as the bus stopped at a bus stop I looked into the window of a private practice and my specialist was in there with what I suppose was a private patient.

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This is why these things should be banned. Anyone trusting NHS hospital senior management over these things is naive and has forgotten that promises are routinely broken without any ethical or moral thought, unless you’re one of them. Even if the person bringing the promise in keeps it, they'll move on and the replacement will see it as non-binding and "best endeavours, unfortunately we need to balance our books".

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The NHS has a new Chair of NHS England, Lord Prior. This role is meant to be an independent non-political figure capable of the oversight of NHS England's running in a different way to the political oversight coming from government ministers. Unfortunately, our nice new Health Secretary has appointed someone who was a Tory Health Minister under Jeremy Hunt. This is in addition to the NHSE Chief Exec being Dido Harding, who is also a Tory Peer and married to a Tory MP.

Come on... at least pretend to play fairly.

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The NHS has a new Chair of NHS England, Lord Prior. This role is meant to be an independent non-political figure capable of the oversight of NHS England's running in a different way to the political oversight coming from government ministers. Unfortunately, our nice new Health Secretary has appointed someone who was a Tory Health Minister under Jeremy Hunt. This is in addition to the NHSE Chief Exec being Dido Harding, who is also a Tory Peer and married to a Tory MP.

Come on... at least pretend to play fairly.

Why should they play fairly? Who will hold them to account? Is there anyone there?

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One thing that has thoroughly depressed me today is reading intervention strategies over increasing numbers of 0-4 year olds being treated in A&E for avoidable dental problems.

One thing that's frustrated me today is people acting surprised that I got a 90% discount on some very expensive courses we're sending people on simply by asking. Apparently no-one had asked before...

One thing that's pleased me today is four organisations who normally wouldn't agree on the colour of white paper signing up to some pretty impressive improvements to healthcare for one of the most deprived areas of England.